Wednesday, January 25, 2012

Name game

I recently switched health clinics. Yesterday I visited my new clinic for the first time. On a wall in the waiting room were the happy, smiling faces of the staff, identified by first name – “Jakob,” “Kristine,” “Marie,” “Samir,” “Erik”, etc. – and job title – doctor, administrative assistant, doctor, doctor, nurse, etc.

Self-reference by first name only is supposed to convey friendliness and feel less intimidating for patients, I assume. But I think it conveys a lack of gravitas I find distressing when it comes to my health. I appreciate friendliness and service with a smile; but both a first and a last name convey a professionalism I find reassuring. When a doctor or nurse uses his full name when introducing himself I feel like he's giving me his complete attention and putting his entire reputation on the line for me. This person is saying “I’m completely committed to your care.”

Although my former doctor put a perfunctory “Dr.” before his first name, i.e. “Dr. Harold,” when he phoned with test results or treatment options, this didn’t cut it either. It’s the way someone talks to children or how people refer to doctors on radio or TV talk shows: I am not seven years old and you are not a media personality. I want to be approached as an adult peer, and I want my medical practitioner to present herself using her first and last name as in any professional relationship: “This is Claris Parnell from the City Health Clinic. I’m calling about….” Or, more traditionally, “This is Dr. Parnell from the City Health Clinic.”

But don’t try and be my “buddy.”  It’s supposed to feel friendly, but I find it forced and phony, and presumptuous. Given a choice, who would you trust: Dr. Hibbert or Dr. Nick?

© 2012 Kvick Thoughts. All rights reserved.

Tuesday, January 17, 2012

Doctors never make mistakes

(To read this article in Swedish, click Läkare är inte ofelbara.)

I had day surgery (in and out the same day) in December to repair a scar from a hysterectomy
about two years ago. Before this most recent surgery, I called Socialstyrelsen (National Board of Health and Welfare) to check the record of the doctor who would be doing the operation. I was told there had been a patient complaint against staff in his unit, including him, but that the complaint had been investigated and it had been determined no mistakes had been made.

No mistakes were made. Yet the desired outcome for the patient who filed the complaint had not been achieved as a consequence of their decisions. Something had gone wrong, but no errors had occurred. It reminded me of my first operation two years ago when the surgeon cut a ureter during the hysterectomy and it had to be reattached. As a matter of routine, I filed an insurance claim with Landstingens Ömsesidiga Försäkringsbolag, LÖF (patient insurance bureau) for financial compensation for some of the ensuing difficulties. But my claim was denied because the doctor had done nothing wrong.

Done nothing wrong? How can this be? Are you supposed to damage the patient’s urinary tract during a hysterectomy?

I know medicine is an art – nothing is guaranteed, outcomes are not always predictable, difficult, unforeseen circumstances are possible, and results can vary depending on the judgment, skill, and experience of the individual practitioner. But there's the rub: doctors are people, and people make mistakes. That’s the human condition. The real question is: should the doctor have known or done better? Did the doctor make a decision or do something other doctors in the same situation would consider unreasonable? Was the doctor negligent?

When Socialstyrelsen and LÖF say the doctor did not make a mistake, what they really mean is the doctor followed a reasonable course of action under the circumstances despite a negative outcome or collateral damage. But the problem is when doctors and others use euphemisms like “complication” instead of the word “mistake,” it ascribes the outcome to unforeseen circumstances or forces over which the doctor had no control and thereby absolves the doctor from direct responsibility for her actions. My ureter did not cut itself. Someone cut it for me.

I’m aware that in my case the circumstances were difficult and that, in fact, to slice a ureter during a hysterectomy is not uncommon. Nevertheless, a mistake was made and by not acknowledging that, we perpetuate the myth that doctors don’t make mistakes when they obviously do. This is a disservice for everyone. It fails to teach doctors humility – there’s nothing more humbling than looking someone in the eye and saying “I did my best, but I made a mistake. I’m sorry.” And it does nothing to help people accept the fact that despite a doctor’s best efforts, mistakes do happen, sometimes, unfortunately, with dire consequences.

I realize that especially in the United States for a doctor to admit a mistake is, for many reasons, to invite a lawsuit. But even in Sweden, where patients cannot sue doctors directly, you see the same reluctance in doctors and regulatory authorities to openly acknowledge and discuss mistakes in medical treatment. When I called Socialstyrelsen to check the record of my most recent surgeon, the woman I spoke with was vaguely hostile and I flat out asked her, “Why are you so defensive? I’m just asking about this doctor and there is no other way to get information.” She relaxed a little and said, “Well, some people…” and trailed off.

The sooner we take doctors off their pedestal, or they climb down themselves, the sooner we can talk more calmly about human fallibility and patient expectations, and the difference between understandable mistakes and negligence. Circumstantial mistake? Small penalty. Negligence? Big problem.

But let’s stop pretending doctors never flub up. People can be surprisingly understanding when talked to honestly and respectfully.

© 2012 Kvick Thoughts. All rights reserved.

(See related posts "We are not Dr. God" and Name game.)